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NAPLEX > IV Medication Principles > Flashcards

IV Medication Principles Flashcards

1
Q

Common vein used for peripheral venous catheters

A

cephalic veins

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2
Q

Limitations of peripheral lines

A

-phlebitis (vein irritation)
-thrombosis
-interstitial fluid extravasation (when it becomes dislodged from the vein and infusion enters surrounding tissue)

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3
Q

Uses for a central Line

A

-highly concentrated drugs
(potassium chloride greater than 20 mEq/L)
-long-term antibiotics
-toxic drugs like chemotherapy with vesicants
-drug with pH or osmolarity different from blood (parenteral nutrition)

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4
Q

extravaste

A

when a catheter tip comes out of the vein and into the surrounding tissue

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5
Q

examples of vesicants

A

-vasopressors (DO, NE)
-anthracyclines (doxorubicin)
-vincalkoloids (vincristine, vinblastine)
-digoxin
-foscarnet
-nafcillin
-mannitol
-mitomycin
-promethazine

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6
Q

Promethazine IV

A

-can cause severe tissue injury
-IM preferred but risk still remains
-if using IV, dilute and limit use
-do not give to children under 2 years of age

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7
Q

Chemical incompatibility

A

drug degradation or toxicity due to:
-hydrolysis
-oxidation
-decomposition

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8
Q

Physical incompatibilities

A

-the container (polyvinyl chloride)
-diluent (dextrose or saline)
-another drug

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9
Q

DEHP

A

-diethylhexyl phthalate (DEHP)
-used in PVC (polyvinyl chloride containers) as a “plasticizer” to make it more flexible
-it can leach into solution
-toxic to liver and testes

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10
Q

Alternative Non-PVC Containers

A

-polyolefin
-polypropylene
-glass

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11
Q

Drugs with leaching/adsorption/absorption issues with PVC Containers

A

“Leach absorbs to take in nutrients”
-lorazepam
-amiodarone
-tacrolimus
-taxanes
-insulin
-nitroglycerin

others: carmustine, cyclosporine, lxabepilone. sufentanil, temsirolimus

*taxanes exception:
paclitaxel-albumin bound (Abraxane) can be placed into PVC container

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12
Q

Drugs that are compatible with saline (No dextrose)

A

A DIAbetic Can’t Eat Pie
-Ampicillin
-Daptomycin (Cubicin)
-Infliximab (Remicade)
-Ampicillin/Sulbactam (Unasyn)
-Caspofungin (Cancidas)
-Ertapenem (Invanz)
-Phenytoin (Dilantin)

Others:
Abatacept, azacitidine, belimumab, bevacizumab, idraucizumab, iron sucrose, ferric gluconate, natalizumab, trastuzumab

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13
Q

Drugs that are compatible with dextrose (No saline)

A

Outrageous Bakers Avoid Salt
-Oxaliplatin
-Bactrim
-Amphotericin B
-Synercid: Quinupristin/ Dalfopristin

Others:
-Carfilzomib
-Mycophenolate
-Pentamidine

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14
Q

High Risk Incompatibilites

A

Ceftriaxone and calcium containing products (lactated ringers)

Calcium and phosphate (often found in TPN and must be addressed)

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15
Q

Drug Compatibility Resources

A

-ASHP Injectable Drug Information
-Trissel’s 2 Clinical Pharmaceutics Database
-King Guide to Parenteral Admixtures
-Drug package insert

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16
Q

most common filter size needed for most drugs

A

0.22 micron filter
(1 micron = 1/1,000 mm)

Parenteral nutrition uses a 1.2 micron filter for the calcium phosphate particulates

-large molecule liposomal formulations cannot be filtered!

17
Q

Common drug with filter requirments

A

my GAL Is PAT who has a MaP

-golimumab
-Amphotericin B (lipid formulations need a 5micron filter)
-Lipids -1.2 microns
-ISavuconazonium
-phenytoin (when administered by continuous infusion, not IV push)
-Amiodarone
-Taxanes (cabazitaxel and paclitaxel)
-Mannitol 20% or greater
-Parenteral nutrition: 1.2 microns

Others:
-Abatacept
-Albumin
-Infliximab

18
Q

Two key drugs that crystallize when kept cold

A

furosemide and phenytoin

19
Q

Key drugs DO NOT REFRIGERATE

A

Dear Sweet Pharmacist, Freezing Makes Me Edgy!

-Dexmedetomidine *but not if diluted
-SMX/TMP
-Phenytoin -crystal
-Furosemide-crystal *but not if diluted
-Metronidazole
-Moxifloxacin
-Enoxaparin

Others:
Acetaminophen, Acyclovir (crystal), deferoxamine (precipitates), levetiracetam, pentamidine (crystal), valproate

20
Q

Protect from light during administration

A

Protect Every Necessary Med from Daylight
-Phytonadione (vitamin K)
-Epoprostenol
-Nitroprusside
-Micafungin
-Doxycycline

Others:
Amphotericin B, Deoxycholate, Anthracyclines, Dacarbazine, Pentamidine

21
Q

Products that foam and need to be swirled when reconstituting

A

-alteplase
-etanercept (Enbrel)
-rasburicase
-quinupristin/dalfopristin (Synercid)
-caspofungin

22
Q

What does discoloration indicate?

A

oxidation or another form of decomposition

23
Q

Dobutamine color change

A

oxidation turns the slightly slightly pink BUT POTENCY IS NOT LOST

24
Q

Nitroprusside color change

A

orange –> brown –> blue
*blue indicates complete dissociation into CYANIDE

25
Q

IV drugs that come colored

A

Anthracyclines (doxorubicin): RED
Rifampin: RED
Mitoxantrone: BLUE

NAPLEX (7 decks)

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